Omur Taskin

High doses of oral contraceptives do not alter endometrial α1 and αvβ3 integrins in the late implantation window

Objective To assess the effects of an emergency contraceptive agent on the distribution of integrin heterodimers during that part of the implantation window. Design Prospective, case-controlled study in a university-based Population Program. In the first ovulatory control cycle after the detection of LH surge, patients had endometrial sampling 11 days after the surge. In the next cycle the procedure was repeated 2 days after the administration of a postcoital contraceptive agent on day 9 after LH surge (100 g ethinyl E 2 and 2mg norgestrel). Main Outcome Measures The effects of postcoital contraceptives on the expression of integrin heterodimers ( α 1 and α v β 3 subunits) reported to be unique to secretory phase was determined. Results All six specimens were consistent histologically with days 24 and 25 of the menstrual cycle by light microscopy. Using immunohistochemistry, strong membrane staining of endometrial glandular cells and superficial epithelium for both α 1 subunit and vitronectin ( α v β 3) receptor was observed in treatment and controls. No diminution of intensity or distribution was observed relative to pretreatment controls. Conclusions There is no apparent change in the level of these two integrins in the human endometrium when high-dose oral contraceptives are given in the later stages of the implantation window. This suggests that the high doses of steroids used in emergency contraceptives may exert their effect through more complex mechanisms than endometrial cell surface changes.

Effects of hormone replacement therapy on bone mineral density in Turkish patients with or without COL1A1 Sp1 binding site polymorphism

Aim:u2002 To evaluate the effects of hormone replacement therapy (HRT) on bone mineral density (BMD) in patients with or without COL1A1 Sp1 binding site polymorphism.

Laparoscopic repair of bladder injury and laceration

The management of bladder injuries at laparoscopy is controversial. Some endoscopists believe in mandatory open repair, whereas others recommend laparoscopic cystotomy repair. We performed laparoscopy to treat two women with bladder injury, one with excision of a transmural nodule of bladder endometriosis, and the other with incidental cystotomy during adenexectomy in the presence of obliterative adhesions. After localizing the injury to the dome of the bladder remote from ureters, the edges of the injury were cleaned of damaged tissue and apposed in two layers using interrupted 4-0 polydioxanone endocorporeal sutures. The patients had an uneventful postoperative course, and neither experienced bladder function problems. We conclude that applying the already established tenets of bladder injury repair by laparotomy to laparoscopic procedures is acceptable in most endoscopic settings.

An incidental diagnosis of well-differentiated papillary mesothelioma in a woman operated on for recurrent endometriosis.

The case presented involves a report of severe endometriosis with recurrent disabling dysmenorrhea associated with well-differentiated mesothelioma. Although the course of mesotheliomas is predominantly benign, the diversity of lesions, variable behavior, and resemblance, and association with endometriosis warrant thorough diagnostic investigation. Multiple biopsies and differential diagnoses are recommended in cases of peritoneal endometriosis.

Triploidy in a growth discordant twin pregnancy after intracytoplasmic sperm injection treatment. Case report.

Objective: We report on a case of a triploidy in one fetus of a twin pregnancy who presented with the findings of growth discordance. Methods: Three weeks’ difference between fetuses in ultrasonographic measurements in the first trimester was observed in a twin pregnancy following intracytoplasmic sperm injection (ICSI) treatment for male infertility. Hydrocephaly developed in the growth-discordant fetus subsequently. Amniocentesis for both fetuses and selective feticide for the abnormal one was performed at 19weeks’ gestation through a single insertion. Fetal karyotype of the abnormal one was 69,XXX and the healthy one was 46,XX. Conclusion: Early developed growth discordance in a twin pregnancy may be a sign of chromosomal abnormality such as triploidy. Those cases should be karyotyped without delay to decrease preterm delivery risk of possible selective feticide.

Comparison of hysterosalpingography and transvaginal hydrolaparoscopy in patients with tubal factor infertility: a prospective cohort study

Aim To evaluate the usefulness, diagnostic accuracy, and cost-effectiveness of transvaginal hydrolaparoscopy (THL) in infertile women with abnormal hysterosalpingogram (HSG) results without obvious pelvic pathology. Material and methods Thirty infertile women (age: 20–40 years) who had tubal pathology in HSG were enrolled in the study. All patients underwent THL instead of standard laparoscopy. A cost analysis was performed comparing HSG and THL methods. Results In comparison of the HSG of cases by considering the chromopertubation results by THL, the sensitivity and specificity of HSG were 85.1% and 56%, respectively. The reasons for preferring standard laparoscopy rather than THL were: failure in accessing of Douglas (n = 3), insufficient monitoring of pelvis (n = 1), hydrosalpinx (n = 1), and intense peritubal adhesion (n = 1), which were 10%, 3%, 3%, and 3%, respectively. The complication rate was 3.8%. Cost analysis of the procedures showed that the total cost of the THL group was 34.8% lower than the HSG group. Conclusions In the elective patients group, THL is more feasible than HSG. Transvaginal hydrolaparoscopy is effective, simple and safe, avoiding the cost, possible complications, time and postoperative patient discomfort compared to conventional laparoscopy.

Term pregnancy after fallopian tube transposition.

A 28-year-old woman suffered from pelvic pain and secondary infertility. She previously had right salpingo-oophorectomy because of ruptured right cornual EP. She was found to have a normal appearing left fallopian tube that entered into a noncommunicating residual horn of the uterus. Microsurgical transposition of the left tube and tubouterine implantation was performed successfully. For cases in which tubocornual anastomosis of the transposed tube is impossible because of previous cornual resection, our technique remains an option.

Delayed-Interval Delivery of Triplet Pregnancy following Preterm Labor

Patients with multiple pregnancies have an increased risk of preterm labor and delivery with the associated high prenatal morbidity and mortality. Obviously, as the number of multifetal pregnancies increases (due primarily to the use of assisted reproductive treatments), a rise in the unexpected birth of one or more siblings at premature or previable stages is observed. In multiple pregnancies with imminent preterm birth, delayed delivery may offer survival chances and a favorable outcome for the remaining fetus(es). Herein, we report on the prolongation of a triplet pregnancy and survival of fetuses B and C after loss of fetus A at 21 weeks’ gestation.

Menstrual Cycle-Dependent Changes in White-on-White Visual Field Analysis of Diabetic Women

Aim: To determine the effect of the menstrual cycle on white-on-white perimetry (WWP) tests of diabetic women. Subjects and Methods: Left eyes of 129 normally menstruating women (81 type 1 diabetes mellitus (DM) with mild (n = 43) and severe (n = 38) non-proliferative diabetic retinopathy (NPDR), and 48 healthy control females) were included in the study. All subjects underwent complete ocular examination and WWP tests both in the follicular (7–10th day of the cycle) and luteal phases (days 3–7 before the bleeding) of two consecutive menstrual cycles. WWP was performed using Humphrey Field Analyzer II with SITA Standard, central 30-2 program. Mean sensitivity (MS) of points located at central 3, 9, 15, 21 and 27° retinal locations (4, 12, 18, 24 and 16 points, respectively) were calculated in all menstrual phases. Results: The mean age of diabetic patients with mild and severe NPDR and control subjects were 28.8 ± 4.7, 30.1 ± 5.9 and 29.4 ± 5.1 years, respectively (p > 0.05). Their mean MS values were 30.7 ± 1.0, 30.4 ± 1.0 and 30.8 ± 0.8 dB, respectively (p > 0.05). Diabetic patients with severe NPDR demonstrated significant decreases in mean MS values of peripheral 21 and 27° visual field locations in the luteal phase (p < 0.05). However, changes in that of the locations within central 15° visual field were non-significant (p > 0.05). Diabetic patients with mild NPDR and control subjects demonstrated no significant changes in mean MS values of any of the visual field locations (p > 0.05). Conclusion: Peripheral, rather than central, locations of central visual field of diabetic women with severe NPDR demonstrated a significant retinal sensitivity loss in the luteal phase. These findings should be taken into consideration during the clinical follow-up of diabetic women at risk of glaucoma and ocular hypertension.